At least 36 million premature deaths could be averted worldwide by 2015, 17 million of them among people below the age of 70, if concerted action is taken to arrest the current spiral of chronic non-communicable diseases (CNCDs), argues an international coalition of researchers that has thrown down the gauntlet by publishing an inventory of 20 ‘Grand Challenges’ in tackling CNCDs.

The publication of Grand Challenges in Chronic Non-Communicable Diseases, a consensus achieved by soliciting and distilling the opinions of 155 geographically and culturally diverse stakeholders from 50 countries, in the latest issue of Nature magazine also marks the formation of the Grand Challenges Global Partnership by the UK’s Oxford Health Alliance (OxHA) and Medical Research Council, the Canadian Institutes of Health Research, the Indian Council of Medical Research and the US National Institutes of Health.

Intended mainly as a co-ordinating body for research funding organisations and efforts to address the CNCD burden, the Grand Challenges Global Partnership will be funded for the first five years by members of OxHA, which has also provided a secretariat. The Oxford Health Alliance is a London-based charity targeting chronic disease that was originally set up in 2003 as a partnership between Oxford University and Novo Nordisk.

The founders of the Grand Challenges Global Partnership aim to expand its membership, seek out collaborative research opportunities and monitor progress towards meeting the identified challenges, which are modelled partly on the Grand Challenges in Global Health initiative spearheaded by the Bill & Melinda Gates Foundation. An advocacy programme will also be developed, to encourage adoption of the challenges and goals.

Unlike the Grand Challenges in Global Health initiative, which included an upfront commitment of $200 million (subsequently increased to $450 million), the Grand Challenges in Chronic Non-Communicable Diseases are not linked directly to any funding programme, the researchers point out in Nature. “These priorities require initial financing, a long-term commitment and a co-ordinated effort between multiple funding agencies around a set of clear priorities,” they comment. “Providing such priorities is the major goal of this grand-challenge exercise. The growing interest in this area of research now being registered by governments and funding agencies suggests that substantial resources may be available in the future.”

Heavy responsibility
According to the article in Nature, CNCDs – which include cardiovascular conditions such as heart disease and stroke, some cancers, chronic respiratory conditions and type 2 diabetes – are responsible for around 60% of all deaths worldwide, some 80% of which occur in low- and middle-income countries. CNCDs account for 44% of all premature deaths worldwide and the overall tally of fatalities from these diseases is double that arising from a combination of infectious diseases, maternal and perinatal conditions, and nutritional deficiencies. Without concerted action, the authors warn, some 388 million people worldwide will die of one or more CNCDs over the next 10 years.

While a number of factors are implicated in the growing burden of CNCDs, including longer lifespans, tobacco use, decreasing physical activity and increasing consumption of unhealthy foods, these diseases are “largely preventable”, the researchers note. Up to 80% of premature deaths from heart disease, stroke and diabetes can be averted with known behavioural and pharmaceutical interventions.

Grouped into six goals, the 20 listed Grand Challenges in Chronic Non-Communicable Diseases are largely geared to preventive and environmental strategies, such as promoting healthy lifestyles, developing codes of conduct for the food and drinks industries or addressing the impact of poverty on risk factors. Goal F, though, which is to do with re-orientating health systems, includes allocating resources within health systems based on burden of disease; increasing the number and skills of health professionals who prevent, treat and manage CNCDs, especially in developing countries; and increasing access to medications to prevent the complications of CNCDs.

The other five goals are A: raising public awareness; B: enhancing economic, legal and environmental policies; C: modifying risk factors; D: engaging businesses and community; and E: mitigating health impacts of poverty and urbanisation.